ABSTRACT Cancer is a leading cause of premature death for parents of dependent children in the United States. Parents with advanced cancer experience profound psychological suffering and many are inadequately prepared for the decisions and consequences associated with their progressive illness and death. Yet there are no effective interventions to reduce psychological distress for these patients. The proposed study addresses this critical gap: we will develop and pilot test a theory-guided psychosocial intervention tailored for parents with advanced cancer and their co-parents (together as a dyad) to reduce their psychological distress and improve end-of-life (EOL) preparation. We will first develop the intervention?psychotherapy counseling visits structured to promote dyadic communication about parenting concerns, using key stakeholder interviews, and then conduct a randomized controlled trial (RCT) with 60 mothers with metastatic breast cancer and their co-parents (an adult identified by the patient to serve as the child(ren)?s primary caregiver if she were to become unavailable). Specific research aims are: (1) to develop a unique, tailored psychosocial intervention to reduce psychological distress in mothers with metastatic breast cancer and their co-parents; and (2) to evaluate the feasibility, acceptability and preliminary evidence for efficacy of the intervention, in a pilot RCT. We hypothesize that improved dyadic communication about parenting concerns and EOL preparation will reduce patients? and co- parents? depression and anxiety. The primary outcome is psychological distress, measured by the Hospital Anxiety and Depression Scale, in patients and co-parents. Secondary outcomes are dyadic communication quality, parenting concerns, EOL preparation - defined as advance care planning for healthcare decisions and parenting, and quality of life. Outcomes will be measured at baseline, 4-, 8-, and 12-weeks (post-intervention). Dr. Park is a psychiatrist with advanced training in psycho-oncology whose long-term goal is to develop and test psychosocial interventions to improve outcomes for patients and families affected by parental advanced cancer. Her short-term career goals for this award are to: (1) obtain education and hands-on training in the design of theory-guided, family-centered psychosocial interventions in oncology; (2) obtain education and training to design, conduct, and evaluate RCTs of psychosocial interventions; (3) acquire education in implementation science to become skilled in the design and testing of pragmatic and sustainable psychosocial interventions in oncology; and (4) develop the expertise, pilot data, and publication record necessary to be an independent investigator. The mentorship and research training resources at UNC create an ideal environment for this career development award. Dr. Park is committed to a research career as a physician scientist and she is uniquely qualified to conduct this study given her research focus on the intersection of psychiatry, oncology and palliative care. This award provides Dr. Park with the necessary education, experiential training, and pilot data for a future large RCT to achieve her long-term goals. 1